To vanquish AIDS by 2030, “pay now or pay forever”

It will cost the world an extra &dollar;30 billion over the next five years to crush AIDS by 2030 – on top of what we already spend. But the payback will be worth it, says a report by UNAIDS, the United Nations programme on AIDS and HIV.

“We don’t have the option of settling for anything less, as we have a fragile five-year window to act,” says executive director Michel Sidibé, who launched the report yesterday in Addis Ababa, Ethiopia.

The target of ending the AIDS epidemic by 2030 was announced last year, with the proviso that it can only be reached if substantially more money is invested to scale up treatment and prevention over the next five years.

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Pursuing this more expensive “fast-track” approach would double the number of people on antiretroviral therapy in poor- and medium-income countries by 2020 compared with 2015. This would require the amount spent every year to gradually increase from &dollar;21.7 billion today to &dollar;32 billion by 2020.

Globally, UNAIDS calculates that this approach could avert 28 million new HIV infections and 21 million AIDS-related deaths between now and 2030, respective reductions of 89 and 81 per cent compared with now. The fall in new HIV infections alone would save &dollar;24 billion in treating that disease.

Bend and break

But if the extra investment isn’t found, UNAIDS says population growth means the epidemic will continue to grow, with 10 times more new infections per year by 2030 and eight times more deaths than now.

“We’ve bent the curve, but to break it we need to take advantage of the fast-track approach over the next five years,” says Peter Ghys of UNAIDS. “Otherwise, the epidemic will continue to rise forever, and the costs will rise forever. So it’s a case of pay now or pay forever.”

What amounts to an ultimatum from UNAIDS arrives alongside much more upbeat news about progress made so far. The annual number of new HIV infections has been reduced to 2 million, the same as in 1990, after a peak of 3.5 million cases in 1997.

Moreover, the aim of Millennium Development Goal 6 to halt and reverse the AIDS epidemic has been achieved, says UN Secretary General Ban Ki-moon in his foreword to the report. “In the year 2000, fewer than 700,000 people were receiving antiretroviral medicines; today, some 15 million people have access, meaning that we have reached one of the most important treatment goals in history,” he says.

“This milestone shows that, together, we can set ambitious, even aspirational, goals, achieve them and then reach for more,” he adds.